INCREASED CEREBROVASCULAR MORTALITY IN PATIENTS WITH HYPOPITUITARISM

OBJECTIVE An increased prevalence of atherosclerosis has been shown am ong patients with hypopituitarism, The aim of the present study was to assess whether patients with hypopituitarism experience increased car diovascular, in particular cerebrovascular, mortality. DESIGN AND PATI ENTS Retrospective cohort study of mortality, 1952-1992, in 344 patien ts, of whom 130 were female, receiving conventional hormone replacemen t for hypopituitarism following neurosurgery for pituitary tumours. Th e general population in the catchment area of southern Sweden from whi ch the patients were recruited constituted the reference population. E xpected mortality was obtained from cause, sex, calendar year, and 5-y ear age-specific death rates for the area. RESULTS Increased mortality from cerebrovascular disease (standardized mortality ratio (SMR) 3.39 ; 95% CI 2.27-4.99) was the main contributor to the increased overall cardiovascular mortality (SMR 1.75; 95% CI 1.40-2.19). The increase in mortality from cardiac diseases was much smaller (SMR 1.41; 95% CI 1. 04-1.88). The risk for cerebrovascular death was higher in women (SMR 4.91) than in men (SMR 2.64). The relative risk for cerebrovascular de ath was independent of the time interval since diagnosis of pituitary insufficiency, but was greater in subjects diagnosed at an earlier age (< 55 years). No increased mortality in malignant tumours was observe d (SMR 0.95; 95% CI 0.60-1.48). CONCLUSION The increased cerebrovascul ar mortality may be due to GH deficiency, or to long-term lack or inad equacy of substitution for other pituitary hormones. The observations that an early onset of pituitary insufficiency and female sex are pred ictors for a high risk for cerebrovascular mortality merit particular attention when treating this group of patients.